20-Hour preprocedural hydration is not superior to 5-hour preprocedural hydration in the prevention of contrast-induced increases in serum creatinine and cystatin C

Background Although intravenous hydration with isotonic saline is the standard therapy for the prevention of contrast-induced nephropathy (CIN), there is still insufficient evidence concerning the optimal timing to initiate preprocedural intravenous hydration with isotonic saline. Methods This study prospectively compared the contrast-induced increases in serum creatinine and cystatin C between 5-hour preprocedural intravenous hydration with isotonic saline (5h-HS) and 20-hour preprocedural intravenous hydration with isotonic saline (20h-HS) in 122 patients with renal insufficiency (estimated glomerular filtration rate of 15–60ml/min/1.73m2) undergoing an elective coronary procedure. The patients were randomly assigned to receive either 5h-HS (n=60) or 20h-HS (n=62). Serum creatinine and cystatin C were measured at baseline, immediately before contrast exposure, and 24hours and 48hours after contrast exposure. The primary end points were the maximal absolute and percent changes in serum creatinine and cystatin C from the baseline up to 48hours after contrast exposure. Results The maximal absolute and percent changes in serum creatinine (0.01±0.13mg/dl vs. −0.03±0.16mg/dl, p=0.16; 0.87±10.05% vs. −1.50±12.92%, p=0.26; respectively) and cystatin C (−0.05±0.17mg/l vs. −0.06±0.17mg/l, p=0.59; −2.94±9.29% vs. −3.46±9.21%, p=0.75; respectively) did not differ between the 2 regimens. Conclusions 20h-HS is not superior to 5h-HS in the prevention of the contrast-induced increases in serum creatinine and cystatin C in patients with renal insufficiency undergoing an elective coronary procedure.